A case of solitary tuberculosis of the liver.

Abstract

The liver involvement by tuberculosis in the macronodular form is quite rare and one must know their clinical features and actual imaging to have precise diagnosis. We present a case of the solitary hepatic tuberculosis, of which angiographic findings originally suggested hepatocellular carcinoma (HCC) given Lipiodol Ultra Fluid (LUF). On angiogram the tuberculoma showed marked hypervascularity in a capillary phase. Histological examination of the biopsy specimen disclosed gramulomas with central coagulation necrosis. A good clinical response was achieved with a course of Isoniazid and Rifammpicin. Angiographic findings of one year later showed hypovascularity. Meanwhile LUF remained long in the tuberculoma marginally, presenting nodular opacities on lipiodolized CT. This finding was different from that of HCC. Wealso discussed those clinical actual imaging and pathological findings.

Tumor-Like Lesions of the Hepatobiliary Tract Caused by Mycobacterial Infections: Tuberculosis and Lepra

“…More recent reports described the principal morphology of primary hepatic lesions and in part emphasize the tumorlike presentation of primary hepatic tuberculosis (Fig. 1;Essop et al 1983a,b;Nagai et al 1989;Oliva et al 1990;Errougani et al 1991;Emre et al 1992;Kok and Yapp 1999b;Sheen-Chen et al 2001;Chen et al 2003;Varela et al 2003). Primary hepatic tuberculosis radiologically manifests as echogenic masses in ultrasonography and hypodense, tumor-like masses on CT images (Kok and Yapp 1999b;Chen et al 2003).…”

The Management of Extrapulmonary Tuberculosis

“…The liver is usually involved by hematogenous spread, particularly in miliary disease (Table 9.2), with a diffuse infiltration (194) which is usually diagnosed on needle liver biopsy. A nodular form of hepatic tuberculosis is also described which can mimic carcinoma or cirrhosis (195). This form can present with bleeding gastric varices (196) or portal hypertension (197).…”

Tuberculoma of the liver

“…[1] Isolated giant solid macronodular tuberculoma of liver[23] is even rarer. Only a few cases are described in the literature and in several of these, the tumor is of small size and not isolated.…”